General Movements Assessment and Hammersmith Infant Neurological Examination for early diagnosis of cerebral palsy in infants born at term treated with therapeutic hypothermia.

Abstract

Aim: To establish if the General Movements Assessment (GMA) and Hammersmith Infant Neurological Examination (HINE) support the early diagnosis of cerebral palsy (CP) in a cohort of infants who have undergone therapeutic hypothermia.

Method: This was a retrospective cohort study from a large single center between 2018 and 2022. Sample size included surviving 112 infants with follow-up (68 males, 44 females) with a mean gestational age of 39 weeks (interquartile range 38-40), diagnosed with moderate or severe neonatal encephalopathy who underwent therapeutic hypothermia. Groups were compared using Fisher's exact and Mann-Whitney U tests.

Results: The absence of normal fidgety movements at the 3-month GMA was highly associated with CP (p < 0.001, sensitivity 89%, specificity 89%). HINE scores were associated with CP at 3 months, 6 months, and 9 months (p < 0.001; sensitivity 82%-90%, specificity 95%-100%). The HINE scores, which optimally differentiated those with and without CP, were less than 47 at 3 months, less than 51 at 6 months, and less than 64 at the 9-month follow-up.

Interpretation: The GMA and HINE were predictive of CP in infants born at term with neonatal encephalopathy who had undergone therapeutic hypothermia. Atypical (absent or abnormal) fidgety movements on the GMA at 3 months and the HINE score at 3 months, 6 months, and 9 months were all highly associated with CP diagnosis with more than 80% sensitivity and more than 90% specificity. The optimal HINE cutoff score for predicting CP may differ from infants born preterm and will benefit from further analysis.